目标:英格兰的卫生政策正在寻求最大限度地减少医院使用,并在初级医疗保健环境中提供服务,并最大限度地提高技能组合。受成本和访问等问题的驱动。这篇综述的目的是确定在普通和口腔医疗保健中增加使用技能组合和服务转移的有效性。次要结果指标与成本有关,质量,access,健康结果和满意度。
方法:数据来源是Cochrane系统评价数据库,DARE审查和传播中心,英国护理指数,CINAHL,EMBASE,MEDLINE,和PsycINFO从1996年到2008年8月。扫描了相关论文的参考列表,以确定其他研究。
方法:系统评价的快速评估,随机对照试验,与专家服务有关的对照试验和服务评估,有特殊兴趣的从业者,医疗和牙科,护理和牙科护理专业人员,以及从二级保健到初级保健的服务转移的证据。
结果:共综述了206篇论文。根据预定义的标准提取并验证发现的所有文章和论文的标题和摘要。两名研究人员对它们进行了相关性筛选,评估试验质量并提取数据。26篇论文符合纳入标准。文献表明,与环境和技能组合变化相关的成本效益和健康结果的证据有限。然而,有证据表明准入有所改善,患者和专业满意度。
结论:迫切需要精心设计的干预措施,并进行强有力的评估,以检查成本效益和对患者和卫生人力的益处。
OBJECTIVE: Health policy in England is seeking to minimise hospital use and provide access to services in a primary healthcare setting and maximise skill-mix, driven by issues such as cost and access. The aim of this
review was to determine the effectiveness of increased use of skill-mix and service transfer within general and oral healthcare. Secondary outcome measures were related to cost, quality, access, health outcomes and satisfaction.
METHODS: Data sources were the Cochrane Database of Systematic Reviews, Centre for Reviews and Dissemination DARE, British Nursing Index, CINAHL, EMBASE, MEDLINE, and PsycINFO from 1996 to August 2008. The reference lists of relevant papers were scanned to identify additional studies.
METHODS: A rapid appraisal of systematic reviews, randomised controlled trials, controlled trials and service evaluations in relation to specialist services, practitioners with a special interest, medical and dental, nursing and dental care professionals, together with evidence of service shifts from secondary to primary care was undertaken.
RESULTS: A total of 206 papers were reviewed. All titles and abstracts of articles and papers found were extracted and validated according to predefined criteria. They were screened for relevance by two researchers, who assessed trial quality and extracted data. Twenty-six papers met the inclusion criteria. The literature demonstrated limited evidence of the cost-effectiveness and health outcomes associated with changes in setting and skill-mix. However, there was evidence of improved access, patient and professional satisfaction.
CONCLUSIONS: There is an overwhelming need for well-designed interventions with robust evaluation to examine cost-effectiveness and benefits to patients and the health workforce.